Wiki Missouri Medicaid

[dsmith03@hotmail.com]

If my physician is non participating with medicaid and sees a pt with Medicaid as primary insurance, does he have to write the visit off? He did not know when the patient came into his outpatient wound clinic

 

[mitchellde]

Is it straight Medicaid , spend down, or Medicaid HMO? If it is one of the HMO plans and this is a participating outpatient clinic then you should be good as long as you use the correct POS. If this is a physician clinic, then you may need to write it off.

 

[dsmith03@hotmail.com]

it is straight medicaid. He saw the patient in an outpatient wound clinic. I believe the facility the clinic sits in is participating.

 

[mitchellde]

If he is a staff provider at the clinic and they are participating then you bill with the 22 POS it should be paid as though he is participating. the way this works is, did the clinic schedule the visit with the provider? If your provider had little to no choice of whether he attended the patient or not then the visit is paid as participating. This works when your provider is simple providing clinic coverage say so many days a week, and the visits are scheduled via the clinic, your provider does not see the patient and then schedule the encounter, they come to the clinic and the clinic basically says you will see this provider today. However if this is a patient your provider has seen and has scheduled to present to the clinic and specifically be seen by your provider then it may not be covered. I hope this is understandable, if not let me know!